1st December 2017, Volume 130 Number 1466

Mortality from cardiac arrest after cardiac surgery—what can be done?

Mr David J McCormack, Mr Cheyaanthan Haran, Mr Paul Conaglen, Mr Nand Kejriwal, Mr Zaw Lin, Mr Nick Odom, Mr Grant Parkinson, Mr Adrian Levine, Dr Tom O’Rourke, Assoc Prof Adam El-Gamel

Waikato Cardiothoracic Unit.

Background

Internationally, mortality following cardiac arrest after cardiac surgery is high. The Virginia State (USA) registry of 79,582 cardiac operations reported the mortality rate of 49–69% in those suffering cardiac arrest after surgery. Factors such as education, teamwork and communication are crucial in improving outcomes. Recent EACTS (2009) and STS (2016) guidelines address the resuscitative management of such patients. The Australasian Cardiac Surgery Advanced Life Support (CALS) Course is taught in Sydney, Melbourne and Adelaide. We report the impact of the inaugural New Zealand on resuscitation team confidence.

Objectives

To assess what can be done to reduce mortality from cardiac arrest after cardiac surgery.

Methods

Multidisciplinary staff from seven New Zealand units participated in a one-day CALS course at Waikato Hospital. Twelve delegates were included. All were ALS trained; none had attended a previous CALS course. Anonymised self-assessment of confidence was documented pre- and post-course using a Likert Scale focused on six domains (overall confidence, managing cardiovascular emergencies, managing respiratory emergencies, managing the airway, assisting in re-sternotomy, perform re-sternotomy). Data was analysed with a Wilcoxon signed-rank test.

Findings

Confidence to assist in a re-sternotomy had the greatest increase after the course (p<0.01), followed by confidence to perform a re-sternotomy (p<0.01), managing emergencies involving cardiovascular problems (p<0.05), managing emergencies involving respiratory problems (p<0.05), managing the airway (p<0.05).

The overall confidence with resuscitation after cardiac surgery increased (p<0.05). 

Conclusions

Significant improvements in confidence in resuscitation after cardiac surgery are achieved following the CALS course. Team dynamics are ALSO enhanced with clearly defined roles.

Rates of unsuspected thyroid cancer in multinodular thyroid disease in Aotearoa

Miriam Karalus, Jade Au Tamatea, Helen M Conaglen, Goswin Y Meyer-Rochow, John V Conaglen, Marianne S Elston

Waikato Clinical Campus, University of Auckland, Hamilton 3240, New Zealand.

Background

The association of concomitant thyroid cancer in multinodular goitre (MNG) has been reported to be about 4%. Cancer risk in toxic MNG was considered to be lower than for non-toxic MNG and attributed to TSH suppression. However, recent international studies suggest an approximate 18% risk of occult malignancy in both toxic and non-toxic MNG.

Objectives

To ascertain the risk of thyroid cancer New Zealand population undergoing thyroidectomy for MNG.

Methods

Single-centre study of patients undergoing thyroidectomy for multinodular disease 1 December 2006 to 30 November 2016.

Findings

Six hundred and two patients underwent surgery for multinodular disease (448 non-toxic and 154 toxic MNG). Of these, 95/602 (16%) had thyroid cancer. After excluding patients with a preoperative suspicion of cancer, 30/401 (8%) patients with non-toxic MNG and 15/151 (10%) with toxic MNG had unsuspected or occult thyroid cancer (p=0.358). Patients with toxic MNG were less likely to undergo preoperative fine needle aspiration than those with non-toxic MNG (34% vs 52%, respectively p=0.0001). Two-thirds of unsuspected thyroid cancers were incidental micropapillary carcinomas, which were unlikely to alter survival irrespective of therapy.

Conclusion

Malignancy rates in MNG are higher than historically reported, although most unsuspected cancers are unlikely to alter patient outcome even if diagnosis is delayed.

Is the medium the message? Format matters in medicines information

Megan Veail, Andre Mutavdzic, Rajan Ragupathy, Jan Goddard

Pharmacy Services, Waikato District Health Board.

Background

Providing tailored information about prescribed medicines to patients is an important part of clinical pharmacy services. A good understanding of the purpose of the medicines and possible side effects may contribute to better compliance as well as reducing risks from inappropriate use of medicines. However, the patients’ preferences and the form in which patients prefer to receive this information has only sparsely been examined.1 This study aimed to examine the patients’ preferences and whether these preferences were affected by demographic factors (self-identified ethnicity, education, age or gender).

Objectives

To ascertain the patients’ preferences and the form in which patients prefer to receive prescribed medicine information.

Methods

A questionnaire requesting demographic data and patient preferences was developed. The choices offered were personalised medication cards, pamphlets, smart-phone app, face-to-face conversation, e-mail and video. Patients were asked to rank their preferences. Choices were then ordered by the percentage of patients who ranked each among their top three preferences. The questionnaire was tested and refined after a pilot study. Patients in Waikato, Thames and Tokoroa hospitals were selected on a random basis. Patients under 18 years old were excluded from the study. The questionnaire was distributed to the selected patients by clinical pharmacists of the wards involved. Patients were left to fill out the questions on their own, and the questionnaires were collected by the pharmacists on the same day.

Findings

Overall the preferred media were face-to-face conversations (81%, 95% CI 71–88%) and personalised medication cards (78%, 95% CI 69–86%), followed by pamphlets (58%, 95% CI 48–68%). Smartphone apps, e-mail and videos were not popular choices in the overall population. Patients under 50 years old showed an increased preference for smartphone apps (67%, 95% CI 41–85%), compared to patients 50 years and older (17%, 95% CI 11–28%). This preference was also shown by Māori patients, but could reflect the younger mean age of hospitalised Māori patients (52 years versus 68 years for non-Māori). Preferences were not influenced by gender or education.

Conclusions

Age and ethnicity may affect the preferred medium for receiving information about medicines, but the patient’s personal preference should be considered when delivering medicines information.

References

  1. Street C. Medicines information: What Matters Most to Patients. Paper presented at the New Zealand Hospital Pharmacists’ Association Conference; Napier (New Zealand); 2015 Aug 28–30.

Findings from the Midland Region Lung Cancer registry

Ross Lawrenson,1,2 Chunhuan Lao,1 Leonie Brown,1 Janice Wong,Karen Middleton2

1University of Waikato; 2Waikato District Health Board.

Background

The completeness and accuracy of the New Zealand Cancer Registry (NZCR) are vital for cancer control in New Zealand. This study aims to report the characteristics of newly diagnosed lung cancer cases and compare the data accuracy of registrations in the NZCR with the Midland Region Lung Cancer register (MLCR).

Objectives

To compare the data accuracy of registrations in the NZCR Midland Region Lung Cancer register.

Methods

Lung cancer (ICD code: C33, C34) and mesothelioma cases (ICD code: C45) diagnosed in 2011–2015 were extracted from both the NZCR and the MLCR. The two datasets were linked by the National Health Index (NHI) number. The cancer extent/stage, date of diagnosis, gender, ethnicity, DHB, date of birth, date of death and date of diagnosis were compared for cancer cases identified in both datasets. For cancer cases diagnosed in the Waikato DHB and identified in the NZCR only, clinical records of these patients were examined to verify the lung cancer or mesothelioma diagnosis.

Findings

In total, 2,126 lung cancer registrations and 81 mesothelioma registrations were identified in the NZCR, including four duplicate lung cancer registrations. Of the 1,570 lung cancer registrations and 59 mesothelioma registrations recorded in the MLCR, 1,483 (94.5%) lung cancer cases and 54 (91.5%) mesothelioma were identified in the NZCR. Of the cancer cases identified in both datasets, 51.3% of the cancer extent in the NZCR was correct for lung cancer registrations and only 17.0% for mesothelioma registrations. The consistency of the two datasets was 99.0% for gender, 96.2% for ethnicity, 98.4% for DHB, 99.7% for date of birth, 94.4% for date of death and 89.9% for date of cancer diagnosis (difference ≤30 days). There are 639 lung cancer registrations and 27 mesothelioma registrations not identified in the MLCR, including 190 lung cancer registrations and 10 mesothelioma registrations in the Waikato DHB. After examining the clinical records of the 200 Waikato patients, 110 (57.9%) were confirmed to be diagnosed with lung cancer or mesothelioma in 2011–2015, 10 (5.3%) were diagnosed with lung cancer or mesothelioma before 2011 or after 2015, 34 (17.9%) did not have lung cancer nor mesothelioma, and 36 (18.9%) could not be verified.

Conclusion

The MLCR provides excellent clinical data on newly diagnosed lung cancer cases. However, there is some under-reporting compared with the NZCR. Combining the two sources of data gives a more complete picture of the incidence of lung cancer in our region.

Improving coronary graft patency with postoperative aspirin and clopidogrel versus aspirin and ticagrelor

Pavan Thanneru,1 Melissa Kirk,Sean Galvin,2 Adam El-Gamell, Scott Harding,2 Madhav Menon,1 Gerard Devlin1

1Waikato Hospital, Hamilton; 2Wellington Hospital, Wellington.

Background

Dual anti-platelet therapy (DAPT) reduces events post-coronary artery bypass graft (CABG).1 In PLATO CABG study aspirin and ticagrelor (AT) was superior to aspirin and clopidogrel (AC).2 The mechanism remains unclear. We hypothesise this may relate to superior graft patency with AT.

Objectives

The primary objective is to compare the effect of dual antiplatelet therapy on the incidence of graft occlusion at 12 months. As assessed by multi-slice computed tomography coronary angiography (CTCA) in patients randomised to AT or AC.

Methods

Randomised, open label design of patients undergoing isolated CABG following an acute coronary syndrome (ACS).

Findings

As of 1 June 2017, a total of 85 patients have been randomised. (43 AT v 42 AC) with 83% male and mean age 63 years. Demographics were similar for both groups. Follow-up results of CTCA were available in 58 patients at 12 months.

CTCA Outcomes at 12 months intention to treat

Aspirin and ticagrelor (n=28)

Aspirin and clopidogrel (n=30)

P

Grafts assessed

94

93

 

Arterial grafts assessed

23

33

 

Any grafts occluded

9 (9.6%)

14 (15.1)

0.36

Arterial grafts occluded

3 (13%)

3 (9%)

0.98

Vein grafts occluded

6 (8.5%)

11 (18%)

0.16

 

Clinical outcomes

Aspirin and ticagrelor (n=32)

Aspirin and clopidogrel (n=31)

P

Death

0

1 (3.2%)

NS

Revascularisation

2 (6.3%)

2 (6.4%)

NS

Symptomatic graft failure

3 (9.4%)

3 (9.7%

NS

CABG related bleeding events

1 (3.1%)

0

NS

Non-CABG related bleeding events

0

1 (3.1%)

NS

 

Reason for study drug discontinuation

Aspirin and ticagrelor (n=32)

Aspirin and clopidogrel (n=31)

P

Need for anticoagulation

2 (6.4%)

1 (3.2%)

NS

Side effect—dyspnoea

8 (25%)

0

<0.01

Clinical event

0

1 (3.2%)

NS

Conclusion

Preliminary results of IMPACT study show that DAPT is safe in post-ACS patients undergoing CABG. No difference is apparent in clinical outcomes or graft patency at 12 months. Significant ticagrelor discontinuation due to dyspnoea (P<0.01).

References

  1. Gao G, et al. Aspirin plus clopidogrel therapy increases early venous graft patency after coronary artery bypass surgery a single-center, randomized, controlled trial, J Am Coll Cardiol, 2010; 56:1639–43.
  2. Held C, Asenblad N, et al. PLATO-CABG. J Am Coll Cardiol 2011; 57:672–84.

Clinical outcomes of overweight or obese patients with stage III colon cancer treated with adjuvant oxaliplatin-based chemotherapy in the Waikato Region

Jayden Wong, Alvin Tan, Sagun Banjade, Michael Jameson

Waikato District Health Board, Hamilton, New Zealand.

Background

According to Ministry of Health statistics, as of 2015/16 data, 35% of New Zealand adults were overweight and 32% were obese. A large retrospective study by Dignam et al demonstrated poorer disease-free and overall survival in obese patients with Duke B and C colon cancer.1 A meta-analysis by Sinicrope et al concluded that obesity is an independent prognostic variable in colon cancer patients.2 We present our local data in the Waikato region, comparing the clinical outcomes of patients with normal weight (NW) and patients who were overweight or obese (OO).

Objectives

To assess the clinical outcomes of overweight or obese patients with Stage III colon cancer treated with adjuvant oxaliplatin-based chemotherapy in the Waikato Region.

Methods

This was a retrospective cohort study of all patients with completely resected Stage III colon cancer who received adjuvant oxaliplatin-based chemotherapy in the Waikato region from 1 January 2008 to 31 December 2013. Patient baseline characteristics, treatment records and cancer-specific outcomes [three-year disease-free survival (3yr DFS) and three-year overall survival (3yr OS)] were recorded. Patient body mass index (BMI) was documented prior to chemotherapy commencement.

Findings

Total of 86 patients with Stage III colon cancer were treated with oxaliplatin-based chemotherapy over this six-year period; 68 patients received FOLFOX6, 16 patients received FLOX and two patients received CAPOX. Among these patients, three patients were underweight (BMI <18.5kg/m2), 25 were of normal weight (BMI 18.5–24.9 kg/m2), 42 were overweight (BMI 25–29.9 kg/m2) and 16 were obese (BMI ≥30kg/m2). Baseline characteristics were fairly balanced, apart from a higher proportion of males (60% vs 28%), Māori descent (14% vs 4%) and left-sided primary site (57% vs 32%) in the OO group, compared to the NW group. 3yr DFS was worse in the OO group than the NW group (70.9% vs 77.3%, p=0.57). 3yr OS was similar in both groups (87.9% vs 88.0%). Chemotherapy dosing was not capped based on body surface area at our institution. A greater amount of oxaliplatin was received in the OO group as a mean percentage of their planned total oxaliplatin dose when compared to the NW group (81% vs 68%), with a lower rate of early cessation of oxaliplatin (41% vs 60%). Rate of any-grade peripheral neuropathy was higher in the OO group (95% vs 76%).

Conclusion

Among patients with Stage III colon cancer, overweight or obese patients demonstrated a poorer three-year disease-free survival when compared to normal weight patients, despite receiving a greater amount of oxaliplatin-based chemotherapy. This difference was not statistically significant; but is in keeping with contemporary literature.

References

  1. Dignam JJ, Polite NB, et al. Body Mass Index and Outcomes in Patients Who Receive Adjuvant Chemotherapy for Colon Cancer. Journal of the National Cancer Institute, November 2006; 98(22):1647–54.
  2. Sinicrope FA, Foster NR, et al. Obesity is an Independent Prognostic Variable in Colon Cancer Survivors. Clinical Cancer Research, March 2010; 16(6):1884–93.

The influence of comorbidity on guideline-concordant surgical treatment for primary breast cancer

Melissa J Edwards,1 Ian D Campbell,1 Ross A Lawrenson2

1Department of Surgery, Waikato Clinical School, University of Auckland; 2National Institute of Demographic and Economic Analysis, University of Waikato.

Background

Patients with breast cancer and concomitant comorbidity have poorer disease prognosis, which may, in part, be related to a reduction in the receipt of guideline-concordant curative treatment.1 Excision of the breast tumour and surgical staging/treatment of the axilla are key components of treatment for non-metastatic breast cancer. In this study, we sought to determine the impact of comorbidity on the receipt, quality and timeliness of surgical treatment for primary breast cancer.

Objectives

To assess the influence of comorbidity on guideline-concordant surgical treatment for primary breast cancer.

Methods

Incident cases of unilateral, stage I–III breast cancer, diagnosed between June 2000 and June 2015 were identified from the prospectively collected Auckland and Waikato Breast Cancer Registers. Comorbidity information was obtained via National Health Index number linkage with administrative hospital discharge data (the National Minimum Dataset), limited to five years preceding the date of breast cancer diagnosis. Comorbidity severity was measured by C3 index score.2 Receipt of surgical treatment, as well as surgical quality and timeliness indicators, were examined with respect to guideline-concordance by C3 score and individual important comorbidities. Guideline-concordance was assigned in relation to the Standards of Service Provision for Breast Cancer Patients in New Zealand3 and St Gallen International Expert Consensus Statements from relevant years. Multivariable logistic regression analyses were performed, adjusted for patient demographic and healthcare access factors, as well as tumour stage. Age and C3 score were modelled using cubic splines due to non-linear relationships.

Findings

Application of the inclusion criteria resulted in the identification of 12,652 patients, with 2,609 (20.6%) possessing at least one major comorbidity. Increasing levels of comorbidity severity were associated with reducing likelihood of receiving surgical excision of the primary breast tumour and operative staging/treatment of the axilla. For patients who received surgical treatment, comorbidity had no impact upon the receipt of definitive quality surgery, defined as mastectomy or breast conserving surgery with a 2mm resection margin negative for invasive/in situ disease. Similarly, comorbidity had no association with receipt of appropriate surgical axillary management. High levels of comorbidity were associated with a reduction in the receipt of timely primary breast surgery (within 31 days of diagnosis).

Conclusion

Compared with their non-comorbid counterparts, comorbid patients with primary breast cancer receive less guideline-concordant cancer surgery. If surgery is performed, it is of equivalent quality but received at greater delay. The impact of inferior surgical treatment on survival in the context of comorbidity is yet to be determined.

Grant support

This work was supported by the New Zealand Health Research Council (Clinical Research Training Scholarship; 17/016), the Cancer Society of New Zealand (Training Scholarship in Cancer Research), the University of Auckland (Research Fellowship in Surgery) and the Waikato Breast Cancer Research Trust.

References

  1. Hong C-C, Ambrosome C, Goodwin P. Comorbidities and their management: potential impact on breast cancer outcomes. In: Ganz P, editor. Improving outcomes for breast cancer survivors: perspectives on research challenges and opportunities. Cham: Springer International Publishing AG; 2015. p. 155–75.
  2. Sarfati D, Gurney J, Stanley J, Salmond C, Crampton P, Dennett E, et al. Cancer-specific administrative data–based comorbidity indices provided valid alternative to Charlson and National Cancer Institute indices. J Clin Epidemiol. 2014; 67(5):586–95.
  3. National Breast Cancer Tumour Standards Working Group. Standards of service provision for breast cancer patients in New Zealand - provisional. Wellington (NZ): Ministry of Health; 2013.

Post-operative cardiothoracic x-ray protocols deliver low clinical yield and results that are not cost effective

Damian Gimpel, EJ O’Malley, Paul Conaglen, Zaw Lin, Nand Kejriwal, Nick Odom, David McCormack, A Prof Adam El-Gamel

The Waikato Hospital, Hamilton.

Background

New literature suggests that routine post-operative x-rays are no longer necessary and should be determined by clinical assessment.

Objectives

To assess if post-operative cardiothoracic x-ray protocols deliver low clinical yield and results that are not cost effective.

Method

A retrospective analysis of the quantity, indications, new radiological findings and medical intervention post x-ray in cardiothoracic postoperative patients. Positive findings were determined from radiological reports and patient notes utilised for management post x-ray.

Findings

Patient cohort n=49 consisted of average age of 61.7±8.41 and an average number of chest x-rays 4.46±2.58. M:F ratio = 5:1. Total number of x-rays performed was n=219 with those undertaken days 0–2 days postoperatively n=169 (60%). Patients requiring change in management post positive finding was n=16 (17%).

The most common indication for imaging was positioning of lines, tubes and drains n=95 (43%) followed by screening for pneumothorax post drain removal in n=55 (20%). Of those 55, chest tube reinsertion occurred in n=6 (11%). New findings found in n=121 images (55%). Most common new finding was postoperative atelectasis, n=63 (52%) followed by pleural effusions, n=40 (33%) of which n=25 (63%) were graded small.

Conclusion

A small number of postoperative chest x-rays had meaningful positive findings and intervention. Each chest x-ray costs $106, potentially saving $69,960 per year by abolishing routine imaging post chest drain removal. Positive findings demonstrated a diagnosis that can be ascertained clinically rather than requiring imaging. A collective effort between cardiothoracic teams and those responsible for postoperative care should aim to reduce unnecessary imaging, decreasing exposure, decreasing money expenditure and improving clinical astuteness.

Microsurgical dexterity tuition of students and house surgeons: a necessary and worthwhile investment

Cheyaanthan Haran,1 Nicholas Brunger,2 Oliver Pumphrey,2 Kelsey Simpson,2 Jacque Roberts,2 Nand Kejriwal,2 Grant Parkinson,2 David J Mccormack,2 Adam El-Gamel2

1School of Medicine, University of Auckland; 2Cardiothoracic Surgical Unit, Waikato Hospital, Hamilton.

Background

The undergraduate curriculum does not include surgical dexterity teaching. Trainees may not attempt microsurgical dexterity tasks until their mid–late 20’s. Waikato Cardiothoracic Surgery Unit introduced a dry-labs course aiming to equip aspiring surgeons with skills to practice microsurgical dexterity.

Objectives

To assess the impact of early surgical skills teaching on a junior cohort of aspiring trainees.

Method

Invited medical students and house surgeons at Waikato Hospital to participate in a four-hour microsurgical dexterity course. The course was created and delivered by a multidisciplinary cardiothoracic faculty. Self-assessment of skill was documented pre- and post-course using a Likert Scale focused on five domains (knot tying, bi-manual microsurgical dexterity, suturing fluency, needle passing skills and tissue handling skills). Quality control aspects of the course were assessed (faculty approachability, course delivery, facilities and catering).

Findings

Twenty questionnaires were returned (nine medical students, 11 house surgeons). Forty percent (8/20) of respondents never practiced their surgical skills in theatre. Knot tying had the greatest increase in self-assessment (p<0.001), followed by tissue handling skills (p<0.001), bi-manual microsurgical dexterity (p<0.001), suturing fluency (p<0.005) and needle passing skills (p<0.01). All quality control aspects of the course rated 4.69–4.75.

Conclusion

Dramatic improvements in self-assessed microsurgical dexterity and self-confidence can be achieved. Further work is required to objectively measure learning and performance curves. It is crucial that students are exposed to a broad surgical skillset early in their career. We propose early training courses as a mechanism to enhance motivation and surgical ability in the future generation.

Association between performance status and tumour response to immunotherapy in patients with advanced melanoma: a single regional experience

Joanne Deacon, Osama SM Salih 

Medical Oncology Department, Waikato Hospital, New Zealand.

Background

On 1 July 2017, PHARMAC amended the funding criteria for PD-L1 inhibitors, pembrolizumab and nivolumab, for patients with advanced melanoma by adding restrictions on ECOG performance status of 0–2. There is no consensus around offering immunotherapy to patients with poor performance status and most of the published trials only include patients with ECOG performance status of 0–1.

Objectives

This study examines the association between performance status and tumour response to immunotherapy in patients with advanced melanoma.

Methods

A study was performed of patients with advanced melanoma treated with immunotherapy at Waikato Oncology Service between 1 July 2016 and 30 June 2017. The electronic chemotherapy prescribing system was used to identify all patients treated during this period. Records were searched to extract patient demographics and treatment-related factors such as ECOG performance, site of metastases, number of doses received, adverse events and radiological response.

Result

Forty-four patients were commenced on, or received treatment prior to 1 July 2017. Thirty-eight patients received pembrolizumab, while only six patients had nivolumab. The median age at the time of immunotherapy commencing was 67.5 years. Approximately 2/3 of patients had more than two medical comorbidities prior to commencing immunotherapy. 18/44 patients had multiple liver metastases, and five had brain metastases. The majority of patients had ECOG performance status 0–1; six patients had ECOG performance status of 2 and none had performance status >2.

Out of 35 patients who have completed their first radiological tumour assessment, 23 patients had tumour response or stable disease compared to 12 patients with disease progression. Of the 23 patients with tumour response, 22 had ECOG Ps of 0–1, and one had ECOG Ps = 2. Four patients died from complications of metastatic disease shortly after commencing treatment; two of these had performance status of 2.

Conclusion

This study has shown that all patients treated with immunotherapy at Waikato Hospital since funding was first approved had a performance status between 0–2. It is unlikely that the new changes to funding criteria will significantly impact upon clinical practice. The study also showed only a small proportion of the patients had ECOG performance of 2 (6/44), however seemed to have worse outcomes.

Development of a qPCR method to measure mitochondrial and genomic DNA damage with application to chemotherapy-induced DNA damage and cryopreserved cells

Stephen Evans,1 Michael Jameson,2 Ray Cursons,1 Linda Peters,Steve Bird,1 Gregory Jacobson1

1Biomedical Research Unit, School of Science, University of Waikato Private Bag 3105, Hamilton 3240, Waikato, New Zealand; 2Department of Oncology, Regional Cancer Centre, Waikato Hospital. Hamilton West 3204, New Zealand.

Background

DNA damage quantitation assays such as the comet assay have focused on the measurement of total nuclear damage per cell. The adoption of PCR-based techniques to quantify DNA damage has enabled sequence- and organelle-specific assessment of DNA lesions.

Objectives

We look at an adaptation of a real-time qPCR technique, to assess DNA damage in nuclear and mitochondrial targets relative to control.

Methods

Novel aspects of this assay include: application of the assay to the Rotor-Gene platform with optimised DNA polymerase/fluorophore/primer set combination in a touchdown PCR protocol. Assay validation was performed using ultraviolet C radiation in A549 and THP1 cancer cell lines. A comparison was made to the comet assay applied to peripheral blood mononuclear cells and an estimation of the effects of cryopreservation on ultraviolet C induced DNA damage was carried out. Finally, dose responses for DNA damage were measured in peripheral blood mononuclear cells following exposure to the cytotoxic agents bleomycin and cisplatin.

Findings

We show reproducible experimental outputs across the tested conditions and concordance with published findings with respect to mitochondrial and nuclear genotoxic susceptibilities.

Conclusions

The application of this DNA damage assay to a wide range of clinical and laboratory-derived samples is both feasible and resource-efficient.

Kaumātua mana motuhake: kaumātua managing life-transitions through tuakana-teina/peer-education

Brendan Hokowhitu, John Oetzel, Rangimahora Reddy, Linda Smith, Mary Simpson, Sophie Nock,
Hineiti Greensill, Michael Cameron, Pare Meha, Kirsten Johnston

University of Waikato.

Background

People face significant transition points as they age, such as loss of independent living, loss of a spouse and changing health conditions. Successfully navigating these transitions depends on being able to manage emotional and socio-economic factors, as well as service systems, while often being reliant on family or whānau. Historically however, kaumātua have faced a dominant society that has failed to realise their full potential as they age. Yet, for Māori, kaumātua are “carriers of culture, anchors for families, models for lifestyle, bridges to the future, guardians of heritage and role models for younger generations.” Kaumātua mana motuhake is invested in upholding kaumātua tino rangatiratanga (independence and autonomy) via high-quality Māori research that will lead to better life outcomes for kaumātua and their whānau.

Objectives

This seeks to address the mana motuhake of kaumātua (older Māori aged 55 or older), through a ‘tuakana-teina’ peer-educator model where kaumātua work with other kaumātua in relation to significant life-transitions. The project investigates the health outcomes of a ‘tuakana-teina’ peer-educator model in relation to wellness, social connectedness, life enhancement, independence and significant life-transitions.

Methods

The research comprises two stages: training of kaumātua who will then serve as tuakana (peer educators) for other kaumātua (teina/peers). The research design is a pre- and post-test, clustered randomised staggered design with Tuatahi (intervention) and Tuarua (control) groups. Tuatahi participate in the training programme initially, while Tuarua participate in subsequent training. The capacity of tuakana is assessed at three stages: pre-test, post-intervention for the Tuatahi group and post-intervention of the Tuarua group. After training, each tuakana will talk with each teina at least three times to address relevant life-transitions of their teina. Teina will also complete three evaluations at the same stages as the tuakana. The research design enables a rigorous comparison of the training while ensuring that all teina receive the intervention.

Findings

The outcome of the research is a manualised intervention bringing a strength-based, holistic and cultural approach to meet social and health needs of kaumātua and their whānau.

Conclusion

We engage stakeholders throughout the research process with the aim of scaling up the intervention, provided it demonstrates efficacy and cost-effectiveness.